Acute Liver Failure pathophys

Question 1

Things to take away

Answer 1

Organs communicate, when one shuts down, others can shut down as well

Question 2

What is fulminant liver failure?

Answer 2

Scary stuff. It’s basically just massive necrosis of liver cells/ dysfunction.

• THere is NO pre-existing disease in the liver
• 66% mortality

Question 3

Less than 2 weeks from onset of jaundice to failure =

Answer 3

Fulminant

Question 4

Less than 8 weeks from onset of jaundice to liver failure =

Answer 4

subfulminant

Question 5

Causes of Fulminant Liver failure

Answer 5

• Viral
• Drugs (acetaminophen)
• Ischemic
• Metabolic
• Miscellaneous

Question 6

Remember, liver can regenerate and is blessed with 2 blood supplies

Answer 6

ok

Question 7

Remember that mushroom poisoning can cause liver failure

Answer 7

ok

Question 8

Budd Chiari syndrome is

Answer 8

Hepatic vein thrombosis

Question 9

What do you look for in a Wilson’s disease pt

Answer 9

History of psychatric problems, odd behavior.

• High serum copper and low ceruloplasmin on lab
• HEMOLYSIS

Question 10

Findings that suggest acute liver failure over Chronic liver disease that has just gotten worse?
Important because the acute failure gets priority in transplant

Answer 10

• No liver history
• Small hard liver
• Large spleen
• Vascular collaterals

Question 11

Acute Liver failure man:

Answer 11

• Confusion, coma in worst case
• Jaundice
• Tachycardia and low bp
• Small hard liver
• Peripheral edema and warm extremities

Question 12

Hepatic Encephalopathy attributed to?

Answer 12

Changes in the BBB with the toxins that build up in the blood due to liver failure

Question 13

Four stages of encephalopathy?

Answer 13

1- normal and alert
2- Increased EEG amplitude and confusion
3- Drowsy with decreased EEG frequency
4- Coma with triphasic waves

Question 14

Early signs of hepatic encephalopathy?

Answer 14

Personality changes then restless delirium

Question 15

Late signs of hepatic encephalopathy?

Answer 15

Rigidity, spasticity, no pupillary reflex

Question 16

What is the most common cause of death due to hepatic encephalopathy?

Answer 16

Cerebral edema

Question 17

Physical findins with COMA

Answer 17

arching of neck, pronation of hands, loss of pupillary reflex, erratic breathing, hyperextended extremities

Question 18

Hypoglycemia often seen in FHF

Answer 18

ok

Question 19

What electrolyte disorder is often present?

Answer 19

Hyponatremia

Question 20

Potassium levels do what during liver failure

Answer 20

They fall

Question 21

Cerebral edema leads to what>

Answer 21

hypoventilation and acidosis

Question 22

High Serum creatinine, low BUN, Renovascular constriction are all signs of what?

Answer 22

Renal failure…bad prognosis

Question 23

Liver failure leads to coagulopathy

Answer 23

this makes sense because the liver produces all clotting factors except for VIII. You’ll see abnormal platelet production and abnormal function. PT/INR are indicators of poor prognosis. Bleeding is a frequent cause of death

Question 24

Prognostic indicators.. these things are bad signs

Answer 24

Age less than 10 or greater than 40
Small liver
Ascites
Jaundice over 7 days
Hypoglycemia
Hepatocyte necrosis

Question 25

What do you want to make sure of before a liver transplant is performed?

Answer 25

• Neuroaxis intact
• No comorbid contraindications
  cardiac, renal, respiratory, psychosocial